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My dad ideally needs PT a couple times a week and OT to optimize function. A past PT who came a few times and an OT who came for an initial eval both refuse to come back again, reportedly due to my dad saying he will be non compliant, and being argumentative about everything, and the OT said he raised his voice. The home health agency is now struggling to find another OT and PT instead. THis would be Medicare covered home health therapy.



An option mentioned is going to a PT/ OT clinical practice, but getting him there twice a week would just not be feasible and he is resistant/ refusing that option - he wants people to come in.



Any ideas on how I should handle this? Should I tell him that its because of his antagonistic behavior that people are not wanting to come? (but I dont think that will be effective with his personality plus dementia - he tends to never accept that his behavior is at fault). The other option is to tell him that PT/OT is just not possible, so he wont get any physical improvements then if he is not fully on board and cooperative?

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My mother (dementia) went from walking well to bedridden in about 2 months. PT at the hospital. PT at the care home. Male, female, young, old... “I don’t wanna! You can’t make me!” She refused to move a muscle. The manager at the home listened to the verbal abuse my mother dished out to see if she could glean anything helpful, anything that might motivate her. Finally they gave up. So frustrating!
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Then he won't receive PT & OT.

File under 'Oh well' 😶

Sorry, I can't think of anything else. All I know is my Oh Well file is growing nicely.
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My mother cooperated with her physical and occupational therapists.

Mom did home health and rehab in her 90’s and improved her strength and balance. She did use a walker but was never in a wheelchair.

This wasn’t easy for her since she had Parkinson’s disease. She had a great attitude and worked hard so it paid off for her. Plus, she had terrific therapists who motivated her. They even played mom’s favorite music while she exercised.

I am sorry that your dad isn’t cooperative with the therapist.

I would ask the staff to talk with your dad about his behavior. Don’t place yourself in the middle of it. He may be more likely to listen to someone else other than you. Or he may not listen to anyone but at least you won’t be tied up in it.
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Good luck dad.

When he becomes wheelchair bound due to lack of physical exertion, and has no core strength left, then he'll be wheeled around like my mother was. And helped out of bed because he won't be able to do it alone.

There are consequences to all actions we take in life. Including those taken by stubborn elders. And there's certain things an MPOA cannot fix for stubborn elders, too. #Fact
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All therapists are not the same. Some know how to work with guys like your dad, and some don’t.

I had great luck with therapy in home for both parents and dh aunt. My mom did her exercise on her own which aunt never did but all were benefitted . . It is simply amazing how little it takes to make a difference.

Something you might consider for your dad is talk therapy. Original Medicare pays for it. You might find someone who would come to him. If dad is good with the phone he could more easily find someone who would call him. This would give him a sounding board for his complaints and might free him up to do pt or ot when he’s had a good vent or has a chance to discuss his issues with someone who seems more on his side.
I have one I talk to twice a week. We often recommend therapy for caregivers but it could also help your dad. Just a thought.

But if dad doesn’t want to do ot/pt, perhaps table it for now and offer again later.
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My dad had many rounds of PT and OT, both inpatient in rehab and outpatient in his home. He loved it and cooperated, by which I mean he loved the conversation and attention, having new people to talk with and spend time with doing something different. The exercises they gave him to do on his own rarely, or ever, happened. After each round of therapy, he’d be at a new, slightly lower level of function. I remember thinking how frustrating the elder age group must often be for therapists. They are tired and hard to motivate, indeed we’ll all be there one day, so I’m not judging. In your shoes, I’d just call it done
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strugglinson Mar 19, 2024
Thanks. I agree.
My Mom (who died 4 years ago), and was very opposite to my dad, was similar to what you describe with your Dad. She felt motivated to try, enjoyed having something to do and someone to chat with a couple times a week, did the sessions but did not really practice much on other days, but did not really make any progress, just slowly declined. Maybe the PT helped to slow down the speed of decline? Who knows, but she was happy with doing the sessions, and the PT was fine with it, so we kept going.
My dad - the opposite in most ways!
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He will never cooperate he has to be the "Big Gun" it is who he is and he has gotten away with this behavior for years, not a new thing.

Why bother with the PT if he will not cooperate? I wouldn't, it is what it is. If he doesn't want to get stronger and do what is needed that is his decision, trying to force the issue will accomplish nothing.

Hang in there, next week there will be another issue to deal with, choose your battles.
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strugglinson Mar 19, 2024
good points
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I would tell him what the "in home" told you. But if like my Dad, he probably would not care. I would tell him though, by being uncooperative, he would probably get worse and when his care becomes too much for you, he will be placed. I'm an not against giving a little threat but you have to mean it.

My Dad had a bad heart and was having problems with his legs. In home was ordered for him. The PT was a woman and came into his home with barrels blazing. "Well, Mr E we are going to do this and that" My Mom said she was overbearing. My Dad told her no d**ned woman was going to tell him what to do. The PT discharged him on the spot. Mom was called and told that Dad can't talk to the PTs that way. Mom admitted Dad is hard to deal with but in his defense, the woman was overbearing. So they sent out another PT and Dad had no problem with her.

If you are Medical POA its probably only in effect when a Dr. says Dad is incompetent to make his own informed decisions. Your part is only to make sure Dads wishes are carried out by Drs and staff. If something comes up that is not covered by the MPOA then you make the decision based on what you feel Dad would want. The MPOA does not mean you physically care for him or need to take him to appts. The MPOA just gives you the ability to talk to Drs and staff and make decisions for Dads health.
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Sadly, every time my mom was prescribed PT/OT after a hospital stay, they only came 2-3 times before they stopped. They would say she was "unable to improve" or some such thing. It was never real PT like I got after a car accident and went for 2-3x/week for 6 or 8 weeks. They didn't do much and mom didn't want them there anyway, so it wasn't a fight worth fighting.
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strugglinson Mar 19, 2024
I agree with your observations also. with 12 days in rehab hospital, it was so good, and did have an impact. Of course, all the therapists were around all day long, so if they came at 8AM and he was grumpy and uncooperative, that therapist could return 2-3 more times that day and try. He got a lot accomplished.
This outpatient twice a week stuff is much more limited. Even if they do come, without him practicing daily the exercises, it may not accomplish anything anyway.
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also - even if they come twice a week, they expect him to do daily exercises on his own. Which he likely wont do, even if he remembers/ is reminded.
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Beatty Mar 20, 2024
That kinda sounds set up to fail..

The norm is get a programe. Client does on own in their home/room.

Only those highly motivated individuals can do so.

To succeed, many may need many things. Need 1:1 staff to do it with them, staff they connect to very well, ensure pain relief is given prior, a clear reward at the end.

The stars to align just right.. not always possibe.
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Tell him that the doctor has prescribed PT/OT and if he does not cooperate he will be required to go into a nursing home and they will make him do it or he can stay in his own home and work with the PT/OT that is sent.
I found if I used my fathers doctors name and his doctor required something then my daddy would be more willing to do what was asked.
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strugglinson Mar 19, 2024
adding the doctors requirement wont change anything for him. He already knows that
if he went home, he would likely do less and not allow them into the house. In fact, he likely would not allow certain caregivers into the house, which is why we have not enabled going home.
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To be honest I would give up on PT/OT at this point.

He has expressed himself as non compliant. IS HE? I am certain he likely is. So that this is a huge waste of funds and resources.

Deterioration is likely inevitable.
I faced this with my brother who ordinarily was so VERY cooperative with everything. He improved so much in rehab a month with exercises for balance. SO MUCH IMPROVEMENT which he actually acknowledged. But once home, and later in ALF he refused to do these simple exercises despite knowing how much they had helped him, and acknowledging that fact. He just wouldn't do it. Other than the fact that he already now suddenly had all SORTS of people at him about what he "should do", and his need as a man who liked control of his own life to have at least SOME control of SOMEthing, there wasn't much I could do to explain this refusal to do the exercises. But he was stubborn and adamant that he would "do them when he wanted" and he never did want to.

I would give up on this. YOU can't control it, either.
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strugglinson Mar 19, 2024
He is non-compliant and realizes that he is non-compliant.
Part of it is that he says he is so tired all the time, and often going to the bathroom with loose stools, he doesnt feel he can keep up with all of these appointments.

I'm ok if he just skips these at this point. I just dont want to be a "Bad POA" or "POA not doing what should be done by a POA"

however, for healthcare decisionmaking, he has not officially been declared chronically incompetent as BarbBrooklyn mentions.

The DPOA pertains to financial stuff. The healthcare proxy document says that I take over in medical decision making when he is not able to , but from my understanding, ability to make own decisions can fluctuate over time I believe....
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SS, I seem to recall that dad is still technically competent. In that case, he is entitled to make his own bad decisions.

He should be told by the administration of the Home Health Agency (not you) that his rude and uncooperative behavior is causing therapy to cease.
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strugglinson Mar 19, 2024
good point. He has not been declared officially incompetent yet, nor declared competent officially. neither - it has not been officially asked.
so you are right probably that means he is technically competent.
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